Before we learn how to generate a Patient Billable from a Closed Insurance Claim, we need to learn about checking EOB (Explanation of Benefits) associated with the final Insurance Payment.
Review the Insurance Payment
The system determines Patient Responsibility by adding together all posted Co-Pay, Co-Insurance, Deductible, and PR- or OA-100+ adjustment codes. Since the system will use this information to generate the billable, it is important to confirm the accuracy of payment posted in comparison to the allocations within the EOB.
- To view the Insurance Payment within the Work Claim screen, select the Payments subtab.
- Within the Payments subtab, locate and select the Check Number to open up the Payment Details window.
- Tip: Locate the line-item of the EOB you'd like to view then right-click the View EOBs hyperlink; select Open in a New Tab to allow you to do a side-by-side comparison.
- In the Payment Details screen, review the EOB and confirm the system mirrors allocations accordingly.
- If changes are required, select the Edit button to adjust the inaccurate fields before selecting Save.
Generating the Patient Billable
Let's review how to generate a Patient Billable from closing the Insurance Claim.
- Once you have confirmed the accuracy of the payment posted, select Close Claim Instance.
- After closing the claim, navigate to the Work Center > Patient Billing > Approve New Billables to view the Billable.
- Select the Billable(s) you would like to approve then select the Approve Patient Billables button.
- After selecting the Approve Patient Billables, the system will redirect you to the Recently Approved Billables section within the Work Center.
- The billable can now be viewed within the Recently Approved Billables section or within the Patient Profile > Patient Billing > Patient Billables section of the Patient Profile.
Note: The system will generate a billable for claims with no Patient Responsibility to ensure accurate reporting and to close the Revenue Cycle.